Health
Vocal Heroes
Do words fail you? Does your speech sound strangled? The experts at Abilene’s Voice Institute of West Texas can help.
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Though there were plenty of otolaryngologists around the state who treated voice and ear problems, there wasn’t a clinic dedicated solely to the voice, not to mention one staffed by three experts who could cover the gamut of vocal dysfunction. “Oddly, the vocal cords are the last thing a lot of people—including doctors—think of when someone starts speaking abnormally,” says King. “They think allergies or viral infection. And even if a voice disorder is recognized, there’s the widespread feeling that nothing can—or should—be done about it. You’re supposed to live with it. We felt some people were suffering unnecessarily.”
A couple of years after they started the Wednesday afternoon clinics, a fourteen-year-old Abilene native named Joe Bob Smith showed up. He was chagrined that his voice wasn’t changing the way his friends’ were. In fact, it had remained girlishly high. “It just didn’t sound right,” he recalls today. “It was coming from the wrong place and weak.”
Smith figured he’d outgrow it, but his mother wasn’t so sure and made an appointment at this voice institute in town that she’d heard about. On the laryngoscope, the three specialists could plainly see that Smith had a rare disorder known as mutational falsetto. The medical literature offered many exotic theories about its causes—including the sufferer’s desire to cling to his childhood—but in this case it was clear that Smith’s problem was physiological: The vocal cords and the muscles of his larynx that supported them seemed in a constant state of extreme tension, causing the reedy quality of his voice. But when he laughed—and instinctively relaxed his larynx—the tone of his voice was much closer to normal.
They asked the boy to try to remember what his voice felt like when he laughed and to emulate that when he spoke. After about six weeks of therapy, “I was speaking in a different voice,” says Smith, who is now an aspiring screenwriter in Hollywood. “When I’d answer questions in class at school, the other kids would turn around and stare.”
In 1995 a 55-year-old Jacksboro schoolteacher named Frances Easter came to the clinic with a tale of having suffered most of her adult life from episodes of strangled, tremored speech. King, Ashby, and Nelson quickly diagnosed her problem as spasmodic dysphonia, which is caused when the nerves from the brain that control the vocal cords misfire unpredictably. Most of us have experienced something similar to this when we have to speak in front of a group and notice a drying and tightening in the throat from nervousness. In Easter’s case the problem had become so acute that it had affected her life. “I had become afraid to volunteer to read at Bible study class for fear it would happen,” she recalls. “It was like a panic attack. Until I went to the clinic, I figured nothing could be done about it.”
Given the duration and degree of her suffering, she says, the cure was surprisingly simple. After anesthetizing her, King injected her vocal cords with a drug called Botox, a new nerve-impulse blocker made from the powerful neurotoxin produced by the botulinum bacterium (the same bug that can cause potentially fatal infections of the gastrointestinal tract). Within weeks, the Botox—which is also used to smooth frown lines and other muscle-related facial wrinkles—had worked so well that Easter was able to speak with ease. “There may be some people who are sorry I found the voice institute,” she says with a laugh. “But I’m glad I did.”
So is Joe Sewell, the final patient this Wednesday afternoon. He has dropped by to have his voice prosthesis checked; last year, after being diagnosed with cancer of the larynx, he had undergone a complete laryngectomy. Despite the fact that the worst possible thing had gone wrong with his voice—because, he admits, he had smoked too many cigarettes for too many years—Sewell is a surprisingly sunny 67-year-old, whose leathery complexion and ropy forearms betray his life’s work as a civil engineer.
Perhaps Sewell is cheerful because, unlike a lot of people who have lost their voice to cancer, he can speak without using an often awkward and embarrassing artificial larynx (a handheld vibrating device that, when held to the neck, projects a buzzing sound into the throat, which air from the lungs then propels upward into the mouth, where it is formed into speech) or relying on esophageal speech, in which air is swallowed, then expelled like a belch up through the esophagus and into the mouth, where the sound caused by its reverberations there is then articulated into words.
Sewell is able to speak using a tracheoesophageal prosthesis that King implanted in his throat. The voice it generates is “actually better than his voice when the cancer was still there,” says Sewell’s wife, Susan. The prosthesis, which is appropriate for only certain patients and has been widely available for only a few years, employs new technology to refine esophageal speech: A permanent opening called a stoma is cut at the sternal notch of the neck, and a shunt, or tube, is threaded between the trachea and the esophagus (which sits behind the trachea). Sometimes a small automatic valve is placed into the stoma. In Sewell’s case, however, a filter was installed in the stoma, and he simply inhales, then closes the air passage with a finger. The air in his trachea is forced through the shunt back into his esophagus, where it then rushes upward into his mouth with such force that it causes the walls of the esophagus and the throat to vibrate and create a sound that can then be articulated into speech. “All I had to do was start talking,” Sewell recalls in a hoarse timbre. “The first words I said were, ‘Susan, you’re in trouble because I can talk!’
“When I learned they were going to take my cords out,” he continues, “the first thing I thought of was having to use one of those awful mechanical things. So much of me is a storyteller. How could I do without a voice? I’m just thankful that God put someone like Dr. King here to do what he can do. You can’t take your voice for granted.”
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